title: Randomized trial evaluating short-term effects of intravitreal ranibizumab or triamcinolone acetonide on macular edema after focal/grid laser for diabetic macular edema in eyes also receiving panretinal photocoagulation.
abstract: OBJECTIVE
  To evaluate 14-week effects of intravitreal ranibizumab or triamcinolone in eyes receiving focal/grid laser for diabetic macular edema and panretinal photocoagulation.
  
  
  METHODS
  Three hundred and forty-five eyes with a visual acuity of 20/320 or better, center-involved diabetic macular edema receiving focal/grid laser, and diabetic retinopathy receiving prompt panretinal photocoagulation were randomly assigned to sham (n = 123), 0.5-mg ranibizumab (n = 113) at baseline and 4 weeks, and 4-mg triamcinolone at baseline and sham at 4 weeks (n = 109). Treatment was at investigator discretion from 14 weeks to 56 weeks.
  
  
  RESULTS
  Mean changes (±SD) in visual acuity letter score from baseline were significantly better in the ranibizumab (+1 ± 11; P < 0.001) and triamcinolone (+2 ± 11; P < 0.001) groups compared with those in the sham group (-4 ± 14) at the 14-week visit, mirroring retinal thickening results. These differences were not maintained when study participants were followed for 56 weeks for safety outcomes. One eye (0.9%; 95% confidence interval, 0.02%-4.7%) developed endophthalmitis after receiving ranibizumab. Cerebrovascular/cardiovascular events occurred in 4%, 7%, and 3% of the sham, ranibizumab, and triamcinolone groups, respectively.
  
  
  CONCLUSIONS
  The addition of 1 intravitreal triamcinolone injection or 2 intravitreal ranibizumab injections in eyes receiving focal/grid laser for diabetic macular edema and panretinal photocoagulation is associated with better visual acuity and decreased macular edema by 14 weeks. Whether continued long-term intravitreal treatment is beneficial cannot be determined from this study.
authors.affiliation: Southeastern Retina Associates, P.C., Knoxville, Tennessee, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Googe
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Brucker
authors.forename: Neil M
authors.initials: NM
authors.lastname: Bressler
authors.forename: Haijing
authors.initials: H
authors.lastname: Qin
authors.forename: Lloyd P
authors.initials: LP
authors.lastname: Aiello
authors.forename: Andrew
authors.initials: A
authors.lastname: Antoszyk
authors.forename: Roy W
authors.initials: RW
authors.lastname: Beck
authors.forename: Susan B
authors.initials: SB
authors.lastname: Bressler
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Ferris
authors.forename: Adam R
authors.initials: AR
authors.lastname: Glassman
authors.forename: Dennis
authors.initials: D
authors.lastname: Marcus
authors.forename: Cynthia R
authors.initials: CR
authors.lastname: Stockdale
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D003930:Diabetic Retinopathy / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D058449:Intravitreal Injections; D017075:Laser Coagulation; D008269:Macular Edema / Q000188:drug therapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D000069579:Ranibizumab; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014792:Visual Acuity / Q000502:physiology
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D014222:Triamcinolone Acetonide; D000069579:Ranibizumab